Improved funding lifts hopes for eating disorders

Individuals with eating disorders are finally able to access an adequate amount of therapy with no out-of-pocket fees, improving their chances of recovery.

From 1 November this year, patients will be able to access 64 new MBS item numbers, entitling them to 40 psychological therapy sessions and 20 dietetic sessions a year.

The decision followed an acknowledgment from the government that eating disorders have an unacceptably high mortality rate and that the health system was not providing the level of treatment required.

The announcement was welcomed by experts who said the existing system, where GPs could only refer patients for 15 sessions of care a year, was inadequate.

Dr Sarah Maguire (PhD), clinical psychologist and director of the InsideOut Institute for Eating Disorders, said the best evidence showed a minimum of 40 psychological sessions were needed to bring about meaningful clinical change, if not recovery.

“If we can get treatment to these people earlier in the course of illness, and get that dose right, this is one of the mental illnesses from which you can make a full recovery,” Dr Maguire told The Medical Republic.

“GPs have such an important role to play if they can identify these illnesses and get these people to a psychologist and if needed, a dietician,” she said.
GPs will act as the gatekeepers for these patients accessing appropriate care, with the item numbers requiring patients to visit their GP a minimum of four times a year in order to remain eligible for treatment.

“GPs will have to monitor the patient’s progress through their sessions and act as the referral agent for each additional set of 10 psychological sessions,” Dr Maguire said.

This will enable GPs to continually assess, diagnose and monitor important behavioural and medical markers of the severity of their patients’ condition and refer appropriately.
But eating disorders are known to be challenging to manage in general practice because the illness can often present alongside serious medical sequelae.

“You can find that a person with an eating disorder can be a bit ambivalent about discussing what’s going on, but if you build a skillset in building rapport with these patients that can diminish those barriers,” Dr Maguire said.

One option for additional training in this area for GPs was a free education module on the InsideOut Institute’s website which provides clinicians with strategies for talking to these patients.
In addition, GPs could get their patient to fill out the EDE-Q, a short self-reporting questionnaire, which, depending on the score, would make them eligible to access the MBS items.“The EDEQ survey also gives clinicians an indicator of both the severity of the eating disorder and the diagnostic category,” Dr Maguire said.

Additional requirements for access include:

A diagnosis of anorexia nervosa or cases or anorexia nervosa that meet the DSM-5 criteria
OR
A moderately severe case of bulimia nervosa with binging behaviours a minimum of three times per week
OR
An atypical presentation of one of those categories